Mitral annular plane systolic excursion (MAPSE) refers to the displacement of the mitral valvular plane in the z-direction and reflects left ventricular longitudinal contraction or shortening, which has been attributed to account for about 60% of the stroke volume 1.
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Terminology
Mitral annular plane systolic excursion is also known as mitral annulus excursion, mitral ring displacement, left atrioventricular plane displacement or similar terms 2.
Usage
Mitral annular plane systolic excursion can be measured for the evaluation of cardiac function in particular global longitudinal function which can be affected in various cardiovascular conditions earlier than other parameters e.g. ejection fraction.
Traditionally mitral annular plane systolic excursion is assessed in echocardiography but it can be also easily assessed in cardiac magnetic resonance cine imaging 2-4. Compared to strain imaging, it depends less on image quality and can be easily obtained with both methods 2-4.
Mitral annular plane systolic excursion can be used for the assessment of prognosis in the following clinical settings 2-6:
- hypertensive heart disease
- aortic stenosis: in particular isolated low-grade aortic stenosis
- hypertrophic cardiomyopathy
- myocardial infarction
- heart failure
- tetralogy of Fallot
- atrial fibrillation
Measurement
Mitral annular plane systolic excursion can be evaluated in any long-axis view in M-mode echocardiography or cardiac MRI by measuring the displacement of the mitral annulus in relation to the left ventricular apex.
Echocardiography
One way to determine mitral annular plane systolic excursion in M-mode echocardiography is to define the mitral annular plane from the lateral and/or septal wall of the annulus in the apical four-chamber view and measure the displacement in relation to the ventricular apex 2,7,8:
- mitral annular plane extraction from the septal and lateral part of the mitral annulus
- M-mode has to be aligned perpendicular to the annulus
- from the lowest point in early diastole to the highest point during systole
- the post-systolic motion should not be included in the measurement
MRI
In cardiac MRI, mitral annular plane systolic excursion can be evaluated in four-chamber cine images similar to the echocardiographic method by measuring the displacement of the lateral and/or septal mitral annular attachments in end-diastolic and end-systolic positions 3-5.
Interpretation
Mitral annular plane systolic excursion reflects global longitudinal function and is a significant independent predictor of mortality in left ventricular dysfunction and major adverse cardiovascular events (MACE) 3-5.
It is usually greater at the lateral attachment than at the septal attachment site 5,9.
A decrease of mitral annular plane systolic excursion indicates longitudinal systolic dysfunction and is seen in myocardial ischemia or myocardial fibrosis. It has been associated with poor outcomes in various cardiovascular diseases 2.
Echocardiography
Echocardiographic assessment suffers from angle dependence 4. Average normal values have been reported in the range of 12-15 mm.
Mitral annular plane systolic excursion ≥10 mm indicates a preserved ejection fraction, <8 mm indicates impaired, and <7 mm indicates severely impaired left ventricular function in normal or dilated left ventricles and was associated with an ejection fraction of <50% and <30% respectively 2.
MRI
Average normal values have been reported in the range of 13±3 to 17±3 mm to the location of the measurement with a displacement of the septal and anterior annular rim being lower than at the lateral and inferior edges 9.
For lateral MAPSE a cut-off value of <9-11 mm has been associated with unfavorable outcomes 3-6.
For septal MAPSE a cut-off value of <9 mm has been proposed as a negative predictor in patients with STEMI 5.
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